Provider Demographics
NPI:1740547801
Name:ELLIOTT, ALICIA M (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 LBJ FWY STE 299
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6439
Mailing Address - Country:US
Mailing Address - Phone:972-755-0996
Mailing Address - Fax:972-386-5229
Practice Address - Street 1:6380 LBJ FWY STE 299
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6439
Practice Address - Country:US
Practice Address - Phone:972-755-0996
Practice Address - Fax:972-386-5229
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66266101Y00000X, 101YM0800X, 106H00000X
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist